Browsing by Author "Twisk, Jos"
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Publication CCTA-Derived coronary plaque burden offers enhanced prognostic value over CAC scoring in suspected CAD patients(2025) Dahdal, Jorge; Jukema, Ruurt; Maaniitty, Teemu; Nurmohamed, Nick; Raijmakers, Pieter; Hoek, Roel; Driessen, Roel; Twisk, Jos; Bär, Sarah; Planken, Nils; Van Royen, Niels; Nijveldt, Robin; Bax, Jeroen; Saraste, Antti; Van Rosendael, Alexander; Knaapen, Paul; Knuuti, Juhani; Danad, IbrahimAims: To assess the prognostic utility of coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA)-derived quantitative plaque metrics for predicting adverse cardiovascular outcomes. Methods and results: The study enrolled 2404 patients with suspected coronary artery disease (CAD) but without a prior history of CAD. All participants underwent CAC scoring and CCTA, with plaque metrics quantified using an artificial intelligence (AI)-based tool (Cleerly, Inc). Percent atheroma volume (PAV) and non-calcified plaque volume percentage (NCPV%), reflecting total plaque burden and the proportion of non-calcified plaque volume normalized to vessel volume, were evaluated. The primary endpoint was a composite of all-cause mortality and non-fatal myocardial infarction (MI). Cox proportional hazard models, adjusted for clinical risk factors and early revascularization, were employed for analysis. During a median follow-up of 7.0 years, 208 patients (8.7%) experienced the primary endpoint, including 73 cases of MI (3%). The model incorporating PAV demonstrated superior discriminatory power for the composite endpoint (AUC = 0.729) compared to CAC scoring (AUC = 0.706, P = 0.016). In MI prediction, PAV (AUC = 0.791) significantly outperformed CAC (AUC = 0.699, P < 0.001), with NCPV% showing the highest prognostic accuracy (AUC = 0.814, P < 0.001). Conclusion: AI-driven assessment of coronary plaque burden enhances prognostic accuracy for future adverse cardiovascular events, highlighting the critical role of comprehensive plaque characterization in refining risk stratification strategies.Publication Homogeneity of the coronary microcirculation in angina with non-obstructive coronary artery disease(2025) Hoshino, Masahiro; Hoek, Roel; Jukema, Ruurt; Dahdal, Jorge; Van Diemen, Pepijn; Raijmakers, Pieter; Driessen, Roel; Twisk, Jos; Danad, Ibrahim; Kakuta, Tsunekazu; Knuuti, Juhani; Knaapen, PaulAims: The homogeneity of coronary microvascular dysfunction (CMD) across different myocardial territories in angina with non-obstructive coronary artery disease (ANOCA) patients is scarcely explored. This study investigates the variability in microvascular resistance reserve (MRR) across the 3 main perfusion territories of the coronary circulation to investigate the homogeneity or dishomogeneity of microcirculatory function. Methods and results: This post hoc analysis of the PACIFIC trials included symptomatic ANOCA patients with [15O]H2O positron emission tomography (PET) and three-vessel invasive fractional flow reserve (FFR). MRR was computed in the three main coronary branches by integrating PET-derived coronary flow reserve and invasive FFR. A total of 155 patients (50% male, age 59 ± 10 years) and 465 vessels (MRR: 3.92 ± 1.21) were included. There were no significant differences in MRR among the three coronary branches. Correlations in MRR among the three coronary branches were good (r = 0.76 to 0.86). The mean difference between MRR measurements in different arteries was small (2.4 to 7.5%), without any consistent directional bias. The overall intra-class correlation coefficient for absolute agreement was 0.80 (95% CI: 0.74-0.85), indicating good single-measure reliability. Approximately 80% (123/155) of patients showed diagnostic concordance of CMD (MRR ≤3.0) across the three vessels. Conclusion: In most ANOCA patients, microvascular function is homogeneously distributed across the three major coronary territories. Single-artery testing may suffice in many cases, aligning with guidelines. However, some patients exhibit notable inter-territorial variation, suggesting that multi-vessel evaluation may be prudent in borderline scenarios.Publication Microvascular resistance reserve in relation to total and vessel-specific atherosclerotic burden(2025) Hoshino, Masahiro; Jukema, Ruurt A.; Hoek, Roel; Dahdal, Jorge; Raijmakers, Pieter; Driessen, Roel; Bom, Michiel J.; Diemen, Pepijn van; Twisk, Jos; Danad, Ibrahim; Kakuta, Tsunekazu; Knuuti, Juhani; Knaapen, PaulAims The relationship between coronary artery atherosclerosis and microvascular resistance remains unclear. This study aims to clarify the relationship between total atherosclerotic and vessel-specific atherosclerotic burden and microvascular resistance reserve (MRR). Methods and results In this post hoc analysis of the PACIFIC 1 trial, symptomatic patients without prior coronary artery disease (CAD) underwent [15O]H2O positron emission tomography, coronary computed tomography angiography (CCTA), and invasive fractional flow reserve (FFR). MRR was assessed across all three coronary branches, utilizing PET-derived coronary flow reserve and invasive FFR measurements. CCTA was used to assess patient and vessel-specific plaque volumes. Percentage atheroma volume (PAV) was defined as total plaque volume divided by vessel volume. The study included 142 patients (55% male, 57.5 ± 8.6 years) with 426 vessels with a mean MRR of 3.77 ± 1.64. While a significantly higher PAV was observed in the left anterior descending artery territory, MRR was similar across the three coronary branches. Generalized estimating equations without correction for cardiovascular risk factors identified that patient-specific PAV tertiles but not vessel-specific PAV tertiles were related to vessel-specific MRR. After correction for cardiovascular risk factors, compared with the first tertile of patient-specific PAV, the second tertile showed a vessel-specific MRR decrease of β = −0.362, P = 0.018, and the third tertile showed a decrease of β = −0.347, P = 0.024. Conclusion In patients without prior CAD, patient-specific plaque burden was negatively associated to vessel-specific MRR; however, vessel-specific plaque burden was not related to vessel-specific MRR. Our findings suggest that the relation between atherosclerotic burden and an impaired microcirculatory function is of systemic origin.